362.6 
N17n 


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ILLINOIS  LIBRARY 
AT  URBANA-CHAMPAIGN 
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THE  NEGLECT  OF  THE  AGED. 


I.  L.  NASCHER,  M.D., 


NEW  YORK. 


REPRINTED  FROM 
THE 


MEDICAL  RECORD 

September' 12,  1914 




WILLIAM  WOOD  &  COMPANY 

NEW  YORK. 


/ 


THE  NEGLECT  OF  THE  AGED. 

By  I.  Li.  NASCHER,  M.D., 

NEW  YORK. 

It  needed  the  pen  of  a  Dickens  to  rouse  the  public 
conscience  to  the  neglect  of  the  dependent  child.  In 
Oliver  Twist,  the  child  of  the  workhouse,  he  planted 
the  germ  of  discontent  with  existing  conditions,  and 
this  germ  grew  and  multiplied  and  spread  until  the 
child  today  has  the  world  for  its  guardian. 

Could  some  kind  Dickens  of  our  time  with  equally 
persuasive  and  forceful  pen  study  and  expose  the 
conditions  in  our  almshouses  and  asylums  for  the 
aged  he  might  with  equal  success  rouse  the  public 
conscience  to  the  neglect  of  the  aged.  And  as  inter- 
est in  the  dependent  child  led  to  the  scientific  study 
of  child  welfare,  so  might  an  interest  in  the  depend- 
ent aged  lead  to  the  scientific  study  of  senility,  of 
the  needs  and  wants,  the  peculiarities  and  infirm- 
ities, the  happiness  and  welfare  of  the  aged.  (There 
is  not,  so  far  as  I  know,  any  organization  taking  up 
the  scientific  study  of  the  aged,  not  a  journal  de- 
voted to  their  welfare,  no  movement  of  any  kind 
interested  in  their  betterment.  International  con- 
gresses are  held  to  discuss  child  conservation,  while 
the  aged  receive  but  the  scantiest  attention.  The 
aged  in  institutions  are  dealt  with  as  they  have  been 


Copyright,  William  Wood  &  Company. 


dealt  with  for  generations,  though  here  and  there 
some  official  who  possessed  the  initiative  and  deter- 
mination, coupled  with  sympathy  and  common  sense, 
has  introduced  innovations  that  tended  to  make  his 
aged  charges  healthier  and  happier. 

The  medical  care  of  the  aged  has  received  but 
little  consideration ;  indeed,  it  is  only  a  few  months 
ago  that  the  first  modern  American  work  on  this 
subject  appeared.* 

It  is  hardly  necessary  to  discuss  the  causes  for 
this  neglect.  I  have  referred  to  this  matter  repeat- 
edly. There  are  few  so  altruistic  that  they  can  com- 
pletely eliminate  thoughts  of  economic  value  from 
their  humanitarian  spirit.  In  a  former  paper  on 
this  subject  I  said:  "In  this  utilitarian  age  we  gage 
the  desirability  of  men  and  things  by  their  practical 
value,"  and  this  applies  as  well  in  the  work  of  phil- 
anthropy as  in  other  fields  of  human  endeavor.  It 
applies  with  special  force  to  the  medical  profession 
who  have  heretofore  neglected  the  aged,  using  the 
term  "old  age"  as  a  handy  excuse  for  a  diagnosis 
and  a  cloak  for  ignorance.  \  We  are  only  beginning 
to  realize  that  old  age  is  not  a  disease  any  more 
than  childhood  is  a  disease — that  it  is  a  period  of 
life  in  which  certain  diseases  prevail,  while  other 
diseases  prevalent  in  earlier  life  do  not  occur;  that 
the  aged  present  many  interesting  medical  prob- 
lems; that  they  require  special  study  and  special 
care. 

But  the  altruism  of  the  physician  is  tinged  with 
the  spirit  of  commercialism,  and  it  is  influenced, 
consciously  or  subconsciously  by  the  factor  of  eco- 
nomic value.    The  child  has  a  prospective  economic 

*Nascher:  Geriatrics.    The  Diseases  of  Old  Age  and 
•    Their  Treatment.    Philadelphia,  1914.    P.  Blakiston's. 
Son  &  Co. 

2 


value,  the  patient  in  the  hospital  may  if  he  recovers 
have  an  economic  value ;  the  aged  are  nearly,  if  not 
quite,  economically  worthless. 

In  many  cases  the  sense  of  uselessness  is  imposed 
upon  the  aged  by  those  who  do  not  know  the  mental 
and  physical  capacity  of  the  aged  individual.  In  a 
mistaken  spirit  of  kindness  the  aged  person  is  with- 
drawn from  his  accustomed  routine  of  life  and  is 
made  to  feel  that  his  usefulness  to  mankind  is  les- 
sened, and  if  he  is  at  all  sensitive  he  realizes  that  he 
is  no  longer  a  producer,  but  a  consumer,  and  a  bur- 
den. Not  only  in  this,  but  in  many  other  directions 
does  the  ignorance  of  senile  mentality  and  the  senile 
organism  tend  to  the  detriment  of  the  aged,  making 
them  more  unhappy,  increasing  their  infirmities  and 
shortening  their  lives.  I  have  visited  a  number  of 
institutions  for  the  aged  and  found  in  every  one, 
even  in  the  best  and  most  elaborately  equipped,  this 
lack  of  knowledge  of  the  senile  mind  and  body  lead- 
ing to  faults  in  the  care  of  the  aged  which  could  be 
avoided. 

Much  can  be  said  in  favor  of  institutional  care  of 
the  aged;  more  can  be  said  against  it.  Where  ex- 
pense is  the  deciding  factor  the  rending  of  home 
ties,  the  separation  from  the  family  and  friends,  the 
changing  of  lifelong  habits,  the  loss  of  self-respect 
in  the  recognition  that  one  is  virtually  a  pauper  de- 
pendent upon  the  bounty  of  the  community  or  body 
maintaining  the  asylum,  the  inevitable  mental  de- 
pression that  follows  inactivity  with  gloomy  retro- 
spection and  dismal  foreboding,  all  these  count  for 
nothing  against  the  lower  cost  of  maintenance  in  the 
institution. 

Dr.  Paul  Ritter,  Minister  of  Switzerland,  informs 
me  that  in  several  cantons — Zurich,  Thiirgau,  Ap- 
penzell,  Uri,  Basel-land  and  Lucerne — the  poor  and 


3 


aged  are  cared  for  in  asylums  and  in  private  fam- 
ilies. Some  place  the  dependents  in  different  fam- 
ilies alternately,  while  Zurich  places' its  dependents 
with  private  families  only  in  the  country  districts. 
He  says  this  system  has  certain  drawbacks  and  has 
'not  proved  to  be  very  satisfactory.  *]From  a  purely 
humanitarian  standpoint  the  family  care  of  the  aged 
is  incomparably  better  than  institutional  care.  The 
child  brought  up  in  an  institution  is  accustomed  to 
institutional  life.  The  aged  find  in  institutional  life 
a  constant,  galling  restraint,  a  severance  of  their 
past  freedom;  family  relations  and  ties  are  dis- 
rupted; domesticity,  privacy,  independence,  the  love 
of  home,  even  interest  in  life  are  lessened,  sup- 
pressed or  entirely  abolished.  ..Life  becomes  one 
dreary,  monotonous  routine,  the  mind  becomes  apa- 
thetic, the  body  becomes  weak,  existence  becomes 
)  automatic;  a  helpless,  hopeless,  purposeless  exist- 
ence  dragging  along  to  its  dismal  end.  How  differ- 
:f  ent  in  lands  where  reverence  is  done  to  the  aged, 
where  sympathy  is  not  measured  by  cost,  where  old 
age  pensions  enable  the  aged  to  maintain  their  little 
homes  or  aid  the  family  to  support  them,  and  not 
\^  force  them  to  the  dreary,  soul-destroying  life  of  the 
poorhouse. 

It  is  not  my  purpose  here  to  appeal  to  the  heart 
(though  I  hope  this  may  touch  the  conscience),  but 
to  show  faults  in  the  care  of  the  aged  in  some  insti- 
tutions that  I  visited,  and  how  some  of  the  faults 
may  be  remedied  with  little  or  no  expense.  We 
must  remember  that  the  asylum  is  usually  the  last 
resort,  that  the  inmates  enter  when  they  can  no 
longer  earn  a  livelihood,  when  they  have  no  means 
or  family  ties  or  when  the  family  cannot  or  will  not 
look  after  them.  The  separation  from  home,  family 
and  friends  is  itself  depressing,  and  this  depression 


4 


4 


is  increased  by  the  sense  of  lost  independence,  in 
enforced  obedience  to  rules  which  ignore  personal 
wishes  and  lifelong  habits,  and  the  sense  of  depend- 
ence upon  public  or  private  bounty.  Other  depress- 
ing influences  are  the  unavoidable  association  with 
undesirable  companions  in  misery,  the  segregation 
of  the  sexes  and  lack  of  mental  occupation,  permit- 
ting the  mind  to  look  back  with  regret  or  forward 
in  despair. 

I  know  of  no  more  senseless,  heartless  rule  than 
the  segregation  of  the  sexes.  In  the  few  institu- 
tions in  which  the  men  and  women  are  permitted  to 
associate  they  take  better  care  of  their  personal 
appearance  and  they  take  an  interest  in  life.  The 
effect  of  segregation  as  compared  with  free  asso- 
ciation of  the  sexes  is  clearly  observable  in  the  New 
York  City  Farm  Colony.  Married  couples  are  housed 
in  cottages,  where  each  couple  occupies  a  separate 
room.  The  inmates  meet  each  other,  take  an  inter- 
est in  each  other's  welfare;  they  take  a  pride  in 
their  personal  appearance  and  in  the  appearance  of 
the  cottage  and  their  rooms.  In  other  parts  of  the 
institution  the  sexes  are  segregated,  the  inmates 
become  indifferent  to  their  appearance,  slouching  in 
their  attitude,  apathetic  or  morose.  The  superin- 
tendent occasionally  secures  the  services  of  an  or- 
chestra or  a  dramatic  company  which  give  a  concert 
or  performance  in  the  open,  the  inmates  sitting  on  a 
terrace  which  they  constructed  for  this  purpose. 
On  these  occasions  the  men  and  women  sit  together 
and  both  men  and  women  fix  up  to  look  neat  and 
clean. 

In  the  Home  of  the  Actors'  Fund,  which  is  con- 
ducted like  a  good  family  hotel,  the  inmates  are 
called  permanent  guests  and  they  associate  as  freely 
as  they  would  at  any  other  hotel.    They  take  pride 


in  their  appearance  and  in  the  appearance  of  their 
Home  and  of  their  rooms,  some  of  which  are  elab- 
orately decorated  by  the  inmates  occupying  them. 
The  inmates  belong  to  the  theatrical  profession, 
and,  being  accustomed  to  hotel  life,  find  here  as  close 
a  semblance  to  their  home  life  as  is  possible  in  an 
institution,  with  the  advantage  of  a  beautiful  situa- 
tion and  beautiful  grounds,  marred  only  by  the 
proximity  of  an  adjoining  cemetery,  a  constant  re- 
minder of  death.  The  dining  room  has  small  tables 
seating  four  to  six  guests.  Aside  from  the  necessary 
restrictions  as  to  rising,  meal  and  closing  hours, 
the  inmates  are  free  to  come  and  go  at  will.  They 
have  a  wTell-stocked  library,  smoking  room,  billiard 
room,  parlor,  sewing  room,  etc.  This  institution, 
now  holding  thirty-five  guests,  and  which  can  hold 
one  hundred,  is  the  model  institution  of  its  kind. 
The  principal  fault  here  is  lack  of  occupation  for 
the  men,  for,  while  they  are  not  accustomed  to  man- 
ual labor,  the  routine  becomes  monotonous  and  they 
become  apathetic.  Being  considered  guests,  they 
are  not  urged  to  do  anything,  and  they  lead  lazy, 
purposeless  lives,  and  mind  and  body  become  "stale" 
from  inactivity.  There  is  no  infirmary  ward,  and 
an  inmate  becoming  ill  remains  in  his  room  while 
a  neighboring  physician  is  called  in.  If  the  illness 
is  serious  the  patient  is  removed  to  a  hospital  sev- 
eral miles  away.  The  superintendent  is  a  graduate 
pharmacist,  well  able  to  take  care  of  minor  ailments 
and  to  give  emergency  relief. 

While  most  of  the  aged  in  institutions  are  more 
or  less  ailing  or  complaining,  few  institutions  have 
a  resident  physician.  In  the  New  York  City  Farm 
Colony,  with  1,000  inmates,  nearly  100  were  in  the 
hospital  wards,  in  charge  of  a  single  nurse  and  one 
visiting  physician.    There  is  nearby  the  Sea  View 


6 


i 

Hospital  for  Tuberculosis,  from  which  a  physician 
could  be  summoned  in  an  emergency,  but  the  interne 
of  a  tuberculosis  hospital  is  as  little  prepared  to 
treat  senile  cases  as  the  ophthalmologist  would  be 
to  perform  a  cesarean  section.  With  a  growing  in- 
terest in  geriatrics  in  medical  schools,  it  should  not 
be  difficult  to  secure  internes  for  homes  for  the  aged. 
Surely  the  aged  invalid,  who  has  sense  and  sensi- 
bilities, who  feels  the  physical  pain  of  disease  and 
the  mental  anguish  of  neglect,  who  has  been  of  some 
service  to  mankind  while  he  was  able  to  be  of  serv- 
ice, deserves  at  least  the  attention  that  is  given  to 
the  idiot  and  imbecile,  who  have  a  resident  physi- 
cian in  their  institution. 

The  National  Home  for  Disabled  Volunteer  Sol- 
diers and  the  various  state  homes  for  soldiers  and 
sailors  generally  make  suitable  provision  for  the  ill 
and  ailing.  Let  me  quote  here  an  extract  from  a 
letter  from  Dr.  James  E.  Miller,  Inspector  General 
and  Chief  Surgeon  of  the  National  Home  for  Dis- 
abled Volunteer  Soldiers: 

"There  are  ten  branches  of  the  National  Home  for 
Disabled  Volunteer  Soldiers.  Each  branch  has  a 
hospital  with  bed  capacity  sufficient  to  care  for  one- 
fourth  of  the  members  present;  comfortably  fur- 
nished, amply  equipped  with  modern  instruments, 
appliances  and  apparatus  necessary  for  the  proper 
care  of  the  sick.  At  four  branches  there  are  spe- 
cial facilities  for  treatment  of  tuberculous  patients. 
The  hospitals  of  the  Home  are  equal  in  points  of 
efficiency  and  equipment  to  the  best  in  the  country. 
There  are  sixty-five  efficient  surgeons  on  the  med- 
ical staff  of  the  Home." 

I  have  not  visited  any  of  these  homes,  and  base 
conclusions  solely  upon  the  published  reports.  The 
inmates  are  well  supplied  with  amusements  and 


7 


recreations,  but  not  with  occupations  which  would 
keep  their  minds  occupied.  This  probably  accounts 
for  the  large  number  of  cases  of  drunkenness  re- 
ported. At  one  branch  680  out  of  968  minor  of- 
fenses were  drunkenness  out  of  an  average  number 
present  and  absent  of  2,626  (1913  report).  The 
food  is  plentiful,  but  some  articles  are  clearly  un- 
suitable for  aged  ailing  individuals. 

The  City  Farm  Colony  is  a  branch  of  the  New 
York  City  Homes  for  the  Aged  and  Infirm,  the  in- 
stitutions formerly  called  the  Almshouse  and  the 
Poorhouse.  Of  its  1,000  inmates  about  100  were  in 
the  hospital  building  and  nearly  700  were  employed 
in  the  fields  and  shops  and  on  construction  work. 
This  institution  can  serve  as  the  model  for  the  sys- 
tematic employment  of  aged  dependents.  The  in- 
mates are  mostly  from  the  lowest  and  poorest 
stratum  of  society,  many  are  ailing,  others  com- 
plaining, others  lazy,  but  the  able  superintendent 
has  succeeded  in  instilling  in  his  charges  a  sense  of 
usefulness,  and  they  work  cheerfully,  many  without 
supervision.  They  are  urged  but  not  forced  to 
work,  they  are  not  hurried,  and  they  rest  when 
tired.  The  men  work  at  trades  with  which  they  are 
familiar,  those  having  no  trade  working  in  the  fields, 
on  construction  work  or  in  the  broom  factory  or 
other  shop  where  skilled  labor  is  not  required, 
working  eight  hours  a  day.  Those  least  able  to 
work  set  and  clear  away  the  dishes  on  the  tables  in 
the  dining  hall,  while  a  few  of  the  more  able-bodied 
and  better-educated  men  are  made  overseers  at  nom- 
inal wages.  The  women  look  after  their  dormi- 
tories, sewing  and  laundry. 

The  work  is  so  thoroughly  systematized  that  there 
is  employment  for  all,  nearly  everything  about  the 
institution,  on  the  fields  and  in  the  shops  is  done  by 


8 


inmates,  and  the  products  of  the  fields  and  shops 
are  disposed  of,  so  that  the  cost  of  maintenance  is 
reduced  to  about  31  cents  a  day  per  inmate,  said  to 
be  the  lowest  cost  per  inmate  in  any  public  institu- 
tion for  adults.  The  great  advantage  is,  however, 
that  the  inmates  have  their  minds  occupied  with 
their  tasks,  they  feel  that  they  are  not  entirely  use- 
less and  their  thoughts  are  not  fixed  on  self  and 
death. 

This  institution  is  conducted  along  strict  institu- 
tional lines,  with  rigid  rules,  clearly  defined  duties 
and  absolute  restrictions.  These  rules  and  restric- 
tions are  probably  necessary  to  control  so  large  a 
body  of  paupers  who  are  unaccustomed  to  cleanliness 
and  order,  yet  much  could  be  done  to  make  their 
lives  brighter  and  make  them  more  comfortable 
without  impairing  discipline.  In  all  my  writings 
I  have  urged  mental  stimulation  as  the  most  effect- 
ive means  of  warding  off  the  mental  depression 
which  leads  to  melancholia  and  dementia.  The 
frightfully  monotonous  life  in  the  institution  leads 
to  a  lethargy  in  which  the  individual  becomes  an 
automaton,  acting  mechanically  through  force  of 
habit.  It  is  a  simple  matter  to  stimulate  interest 
in  life  while  the  individual  still  has  some  interest; 
it  is  difficult  to  rouse  him  out  of  his  lethargy  when 
he  has  once  reached  that  condition.  One  of  the  most 
potent  measures  to  keep  up  interest  in  life  is 
through  newspapers  and  the  discussion  of  the  af- 
fairs of  the  day.  Newspapers  and  other  reading 
matter  could  probably  be  obtained  at  little  or  no  ex- 
pense, but  the  aged  generally  have  presbyopia,  and 
they  cannot  read  without  proper  glasses.  The 
mental  impression  produced  when  we  read  a  paper 
is  much  more  powerful  and  lasting  than  when  we 
hear    it    read.      If    these    poor    people  were 


9 


supplied  with  glasses  and  newspapers  they 
would  take  a  greater  interest  in  life  and  in  them- 
selves. Here  is  a  fruitful  field  for  public  and  pri- 
vate philanthropy.  I  was  informed  that  no  pro- 
vision was  made  for  recreation  or  amusement,  that 
the  superintendent  upon  his  own  initiative  secured 
the  orchestras  and  dramatic  talent  which  gave  the 
occasional  performances  to  the  inmates.  On  rainy 
days,  when  the  inmates  cannot  go  to  the  shops  or 
work  in  the  fields  they  remain  indoors  and  do  noth- 
ing— nothing  but  think  with  regret  of  the  past,  in 
despair  of  the  future.  There  is  no  piano  or  phono- 
graph to  chase  sad  thoughts  away,  no  games  like 
checkers  or  chess  to  while  away  dreary  hours.  True, 
they  are  paupers,  they  may  have  been  improvident ; 
now  they  are  unfortunates  and  look  for  sympathy 
and  kindness. 

In  one  institution  near  Vienna  there  are  enough 
inmates  able  to  play  musical  instruments  to  form  a 
good-sized  band,  and  they  give  occasional  public 
concerts.  The  income  from  these  concerts  supplies 
the  inmates  with  little  luxuries  which  they  procure 
at  a  canteen  on  the  grounds.  It  would  probably  not  be 
possible  to  recruit  an  orchestra  from  the  inmates  of 
the  Farm  Colony,  but  out  of  a  thousand  inmates  one 
or  several  would  be  found  who  could  play  the  piano. 

A  universal  fault  in  institutions  for  the  aged  is 
improper  feeding.  The  falling  out  of  the  teeth  is 
nature's  signal  that  food  which  must  be  masticated 
is  to  be  avoided.  The  principal  article  of  diet  which 
requires  chewing  is  meat.  Almost  all  other  foods 
can  be  crushed  between  the  tongue  and  hard  palate, 
either  dry  or  when  moistened  or  soaked.  Fats  and 
insipid  articles  of  food  are  distasteful  and  they 
should  be  avoided  on  physiological  grounds.  While 
it  is  not  practicable  in  a  large  institution  to  furnish 


10 


meals  suitable  to  each  individual,  it  is  possible  to  so 
arrange  the  dietary  that  those  unable  to  chew  can 
get  sufficient  food  without  meat.  In  the  New  York 
City  Home  a  pious  Jew  would  not  eat  proscribed 
dishes  and  almost  starved  until  he  was  transferred 
to  a  Jewish  home  for  the  aged.  In  one  institution 
the  superintendent  introduced  a  cathartic  in  the 
food  one  day  each  week,  a  pernicious  practice,  heart- 
less as  well  as  ignorant.  Drugs  should  never  be 
given  indiscriminately,  never  without  a  physician's 
order,  or  so  as  to  incommode  other  inmates. 

A  fault  which  prevails  in  many  institutions  is 
inadequate  bathing  facilities.  The  aged  find  it  dif- 
ficult to  enter  a  bath  tub  and  more  difficult  to  get 
up  after  the  bath.  Stout  women  are  often  unable 
to  get  up  without  assistance,  and  for  this  reason 
they  dread  the  bath  tub.  This  trouble  can  be  avoid- 
ed by  using  a  shower  bath  and  allowing  the  bather 
to  sit  upon  a  chair. 

In  one  institution  there  were  no  carpets  on  the 
floor,  the  inmates  were  not  permitted  to  go  barefoot, 
but  several  had  bladder  and  prostatic  troubles  which 
compelled  them  to  go  to  the  toilet  at  night.  When 
this  happened  they  awoke  the  whole  dormitory.  A 
strip  of  carpet  removed  this  source  of  insomnia. 
In  ■  another  institution  the  windows  were  opened 
during  the  day  even  in  winter.  At  night  they  were 
closed  and  the  heat  was  turned  on.  The  bedding 
during  the  day  was  folded  over  the  foot  of  the  bed 
and  the  bed  was  still  cold  when  the  inmates  retirea. 
They  could  not  fall  asleep  until  the  heat  from  their 
bodies  warmed  the  bed  sufficiently  to  make  them 
comfortable,  and  those  who  had  bronchitis  began 
coughing  as  soon  as  they  entered  the  cold  bed.  As 
there  were  a  lot  of  empty  mineral  water  jugs  in  the 
cellar,  I  suggested  that  the  inmates  fill  these  with 


11 


hot  water  and  each  one  put  a  jug  in  his  bed  as  soon 
as  he  went  to  the  dormitory  after  supper,  and  when 
he  entered  the  bed  he  could  push  the  hot  jug  to  the 
foot  of  the  bed  and  keep  his  feet  warm. 

Many  aged  persons  have  bromidrosis,  and  where 
a  large  number  congregate  in  a  room  the  odor  soon 
becomes  exceedingly  offensive.  In  one  institution 
there  is  no  infirmary  w7ard,  and  there  are  several 
bedridden  cases  in  the  dormitories.  During  a  cold 
spell  the  windows  could  not  be  opened  for  a  few 
days,  as  the  bedridden  patients  could  not  be  shifted 
and  the  atmosphere  became  nauseating.  In  one  in- 
stitution the  inmates  are  paired  off  co  that  each  one 
has  a  companion.  The  companion  of  an  inmate  who 
had  hemiplegia  acquired  through  mimicry  a  similar 
gait,  and  in  another  case  an  inmate  acquired  a  senile 
tremor  in  like  manner.  Separation  and  disciplinary 
measures  were  necessary  before  it  was  possible  to 
overcome  these  habits.  In  another  case  association 
with  a  garrulous  dement  resulted  in  a  quarrel  in 
which  the  dement  was  injured  and  the  other  devel- 
oped delusions  of  persecution. 

Other  faults  frequently  met  with  in  institutions 
are  neglect  of  the  petty  ailments,  such  as  broken 
down  arches,  corns  and  bunions,  pruritus,  pains  in 
the  joints  (arthrosclerosis),  etc.;  lack  of  canes,  the 
presence  of  curiosity  seekers  and  professional  sym- 
pathizers, inadequate  facilities  for  holding  religious 
services,  mingling  of  nervous  and  mental  defectives 
with  impressionable,  healthy  cases,  irrational 
amusements  and  recreations,  uniform  costumes, 
sometimes  lack  of  sympathy  and  interest  on  the  part 
of  the  superintendent  in  his  charges,  more  often 
failure  to  encourage  interest  of  the  inmates  in  their 
institution. 

Not  alone  should  the  inmates  of  asylums  for  the 


12 


aged  be  urged  to  keep  their  minds  and  bodies  em- 
ployed, they  should  be  permitted  to  dispose  of  their 
products  or  abilities  and  use  their  earnings  for  the 
general  betterment  of  their  institution.  The  object 
should  always  be  to  instil  a  sense  of  usefulness,  even 
if  it  be  only  the  ability  to  go  on  errands. 

Segregation  of  the  sexes  should  be  prohibited, 
and  as  the  association  of  the  sexes  will  rouse  pride 
in  appearance  they  should  have  the  facilities  to 
enable  them  to  make  a  good  appearance.  This  is  not 
so  important  in  soldiers'  and  sailors'  homes,  but  in 
other  homes  this  separation  from  the  opposite  sex 
is  a  hardship  for  which  no  good  reason  can  be  given. 
Such  association  will  arouse  interest  in  others  and 
in  the  surroundings.  A  distinctive  pauper  costume 
is  as  humiliating  as  are  the  prison  stripes. 

In  the  course  of  this  paper  I  have  touched  upon 
some  other  factors  applicable  to  the  institutional 
and  communal  care  of  the  aged  which  should  receive 
careful  study.  Such  are  the  cottage  system  of 
housing,  the  distribution  of  aged  dependents  among 
families,  the  earning  capacity  as  a  contribution  to 
the  cost  of  maintenance,  systematic  employment,  the 
canteen,  stimulation  of  interest  in  the  institution 
and  in  self,  etc.  The  City  Farm  Colony  has  a  well- 
equipped  printing  office  manned  by  inmates,  which 
could  publish  a  weekly  or  monthly  journal  dealing 
with  the  institution  and  department  and  to  which 
inmates  could  contribute. 

These  matters  deserve  attention  and  study,  far 
more  study  than  one  individual  working  without 
assistance  can  possibly  give  to  them.  But  to  re- 
ceive attention  it  will  require  the  forceful  and  per- 
suasive pen  of  a  Dickens  to  rouse  the  public  con- 
science to  the  neglect  of  the  aged. 

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Th*  Occupational  Neuroees  A  Clin- 
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Failure  of  tha  Colon  to  Rotate.  By 
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On*  Taar'a  Experience  with  Salyar- 
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Meigs.  M  D..  and  Howard  L> 
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Not**  on  the  Neurology  of  Voluntary 
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Dearborn.  M.D..  Boston,  Mass  

Notes  Upon  a  So-Called  Parasite  of 
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tides  Agramonte.  A.B..  M.D.,  Ha- 
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Chorloeplthelloma  Mallgnum:  Report 
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ries Retained.  Complete  Recovery; 
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ologtat.  By  Wra.  H.  Dukemaa. 
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Hysteria  and  Psychotherapy  By 
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A  Suggested  Readjustment  of  Our 
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tin. M.D..  Montreal.  Can  

Some  Points  In  the  Diagnosis  and 
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M.B.,  London   - 

EDITORIALS. 

Mora  Bleep   :......<■«. 

The  Professional  Secret  and  tha  Re- 
porting of  Venereal  Diaeaaea  

Finger-Print  Evidence........  — 

Freeh  Air  In  School*  and  HaaMlal* 

EDITORIAL  NOTIS. 

Kephretyphu*  —  Athlete*  and  Vtmt 
JJf*   

The  Discretion  of  the  Surgeon  

Selenium  In  the  Treatment  of  Cancer 

The  Seriousness  of  Meastea  

The  Triumph  of  American  Medicine  In 
the  Conatrtictlon  of  tha  Panama 
Canal   


NEWS  OF  THI  WEEK. 
Practical  Eugenics — Meaalcs  Prevalent, 
— For  Pure  Water — Smallpox  Epi- 
demic— Surgery  Under  Difficulties 
— Newspapers  Kelp  Tuberculosis 
Fight— Wood  Alcohol  Poisoner*— 
Radium  Standard— Heredity  and 
Hare  Lip — Candidates  for  ,  Nobl« 
Prise— Resignation  of  A  Hospital 
Staff— Charitable  Gifts— New  Hos- 
pital for  Colored  Person*  ,.. 

Nurses  Revise  Their  Charges — Wemen 
Physicians  Try  for  Ambulance  Serv- 
ice—"Healer"  Found  Culfiy— En- 
dowment Fund  for  Homeopathy- 
American  Medical  Editors'  Asso- 
ciation— Venereal  Dtseaaea  to.  8* 
Reported  In  New  York — Meningitis 
In  Oklahoma — Health  of  th*  Canal 
Zone — Tuberculosis  Among  Alaska, 
In  New  York..._ 


OBITUARY 
John  Herr  Musser.  MD..™, 

Leonard  Weber.  M.D  

Charles  Bell  Converse.  M.D  ... 
Thoma*  Dwlght.  M  D.    L.L.D. . 

CORRESPONDENCE. 
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PROGRESS  OF  MEDICAL  SCIENCE, 
End  Result*  of  Surgery  In  Neurax- 

tltenles  and  on  Neurasthenia  

Primary  Turner*  of  th*  Spleen  — 
Urinary  infection  —  The  Prevention 
•f  Eclampsia  —  ChVloue  Ascites  — 
Relation  of  Intestinal  Toxemia  to 
Chronic  Arthritis— Creative  8urgery 
Combined  Infestation  with  ~  Ascarle 
and  Hookworm — Extradural  Hemor- 
rhage—  Anesthesia  In  Tonsil  Enu- 
cleation—Antityphoid  Vaccination— 
Convalescent  Carrier*  of  Typhoid— 
Streptococcus  Vaccina*  In  Scarlet 
Fever   Prophylaxis  .-.  

INSURANCE  MEDICINE. 

Suggestions  to  Medical  Examiner*. 
By  th*  Insurance  Editor  Th* 
Physical  Examination  .  

Wessermann  Reaction  lit  Judging  a 
Claim  for  Indemnity — A  Case  *f 
Multiple  Sclerosis  from  Chrerrle  Oaa 
Poisoning  

The  Mortality  of  Alcohol—  Medical 
Section  of  th*  American  Life  Con- 
vention— Pleurisy  and  Insurance  . 


BOOK  REVIEWS. 

A  Practical  Medical  Dictionary  *f 
Words  Used  In  Medicine.  With 
Their  Derivation  and  Pronunciation. 
Including  Dental.  Veterinary. 
Chemical.  Botanical,  Electrical.  Ufa 
Insurance  and  Other  Special  Term*. 
By  Thomaa  Lathrop  Stedman.  M.D 
Illustrated   

American  Practice  of  Burgery  A 
Complete  System  of  the  Solence  and 
Art  of  Surgery  by  Representative 
Surgeon*  of  the  United  State*  and 


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llustrated.    Volume  VIII  

Utle 

Palate.  By  John  B, 
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with  171  engraving*  

SOCIETY  REPORTS. 

Mississippi  Valley  Medical  Association 

American  Aaaociatlon  of  Medical  Ex- 
aminers  , 

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Southern  Surgical  and  Gynecological 
Association  

New  York  Academy  of  Medicine  

The  Western  Surgical  Association;.. 

Connecticut  State  Medical  Society.  t. 

'MEDICOLEGAL  NOTES. 

Malpractice— Responsibility  for  Op- 
eration Conducted  by  Another  

Finger  Print  Impressions  ••  Evidence 
— Testamentary  Capacity— Effect  of 
Disease — Dentist  Not  a  Surgeon 
Within  Statute  on  Privileged  Com- 
munications —  Scope  or  Privileged 
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Power  to  Contract  for  Medical  Ser- 
vice*—Expert  Evidence  la  Miwrler 

cm*   ...» 

state  medical  licensing  boards. 

■tat*  Board  Examination  Question* — 
Ohio  silt*  Medical  Board  


Que 
Boa 


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Bulletin  of  Approaching  Examination* 

NEW  INSTRUMENTS. 
A  Needle  Holder  for  th*  Intra venoo* 
Administration   of   falvaraan.  Bp 
Hubert  Y  Oull*.  M.D.,  New  York. 

MEDICAL  ITEMS. 
Contaglevm  D'seases — Weekly  St**** 

ment— Health  .  Report*  

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